| NPI | 1992191266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME157540) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV 19688) |
| 208D00000X General Practice (Licence: LA 321700) | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2024-07-20 |